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Mod B > Gynae > Flashcards

Gynae Flashcards

1
Q

Risk factors for thrush

A

Diabetes
Recent antibiotics
Pregnancy
Immunosupression

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2
Q

Management of thrush

A

Oral fluconazole 150mg
Clotrimazole pessary
If pregnant - just pessary

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3
Q

Adenomyosis

A

Presence of endometrial tissue in the myometrium

Presentation:

  • Dysmenorrhoea
  • Menorrhagia
  • Enlarged uterus

Investigations:

  • MRI pelvis
  • Transvaginal US

Management:

  • Symptomatic treatment e.g. tranexamic acid to manage menorrhagia, mefenamic acid for pain
  • GnRH agonists
  • Uterine artery embolisation
  • Hysterectomy
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4
Q

Fibroids

A

Presentation:

  • Menorrhagia
  • Abdo pain
  • Bloating
  • Urinary symptoms

Investigations:

  • Transvaginal US

Management:

  • Symptomatic treatment
    tranexamic acid to manage menorrhagia, mefenamic acid - pain
  • IUS
  • Combined pill
  • Progesterone pill
  • GnRH agonists - short term to reduce size
  • Myomectomy if larger than 3cm
  • Hysterectomy
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5
Q

Presentation of ectopic

A

Lower abdo pain
Shoulder tip pain
Bleeding
Dizziness

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6
Q

Risk factors for ectopic

A

IUD
PID
Endometriosis
Tubal surgery
IVF pregnancy
Progesterone only pill
Previous ectopic

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7
Q

Most common site of ectopic

A

Tubal - ampulla

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8
Q

Site of ectopic with most risk of rupture

A

Isthmus of tube

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9
Q

Investigation and management of ectopic

A

Investigation:
- bHCG test
- Transvaginal US

Management:

  • If small (<35mm) and asymptomatic, with HCG of less than 1000 - watch and wait
  • If small, no sig pain, HCG of less than 1500 - methotrexate
  • If large (>35mm ) or pain, or detectable foetal heart, or HCG more than 5000 - salpingectomy/salpingotomy + methotrexate (plus anti D if relevant)
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10
Q

Types of miscarriage

A

Cervical os closed:
- Threatened - painless bleeding before 24wks
- Missed - some bleeding, dead foetus remains in utero

Cervical os open:
- Inevitable - heavy bleeding, POC not yet passed
- Incomplete - pain and bleeding, not all POC expelled

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11
Q

Management of miscarriage

A
  • Expectant
  • Medical - Misoprostol (+ antiemetics and pain relief)
  • Surgical - misoprostol (to soften) plus vacuum aspiration under LA or GA
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12
Q

Management of PMS

A

1 - diet and exercise
2 - Combined pill
3 - SSRIs (continuous or phasic)

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13
Q

Management of stress incontinence

A

1 - pelvic floor training
2 - Duloxetine ‘locks it in’

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14
Q

Management of urge incontinence

A

1 - bladder retraining for 6 weeks
2 - Oxybutinin or solifenacin for elderly (less risk of falls)

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15
Q

Endometrial cancer

A

Presentation:
- Post menopausal bleeding

Investigations:

  • Transvaginal US (<4mm)
  • Hysteroscopy and biopsy

Management:

  • Total abdominal hysterectomy and bilateral salpingooopherectomy
  • Progesterone if elderly and can’t have surgery
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16
Q

Risk factors for endometrial cancer

A

Obesity
Nulliparity (progesterone during pregnancy is protective)
Early menarche
Unopposed oestrogen
Diabetes
Tamoxifen
PCOS
Hereditary non-polyposis colorectal carcinoma

17
Q

Cervical smear screening

A

Tests for strains of HPV that are high risk for causing cancers

  • If +ve HPV, send for cytology. If normal repeat in 1 year. If normal return to normal cycle. If not, repeat again in 1 year. If positive for a 3rd time - colposcopy.
  • If +ve HPV and abnormal cytology. Send for colposcopy.
  • If 2 inadequate samples - colposcopy.
18
Q

Medical management of termination of pregancy

A

1 - mifepristone - orally
2 - 48hrs later misoprostol vaginally

19
Q

PCOS

A

Presentation:

  • Subfertility
  • Oligomenorrhoae/amenorrhoea
  • Hirsutism
  • Acne
  • Obesity
  • Ancathosis ingrains

Investigations:

  • Pelvic US - cysts
  • LH:FSH inc, TSH, prolactin, testosterone, SHBG
  • Exclude other conditions

Management:

  • Weight
  • COC pill
  • Clomifene (anti-oestrogen) to help ovulate
20
Q

Ovarian hyperstiulation

A

Range of presentation from mild to life threatening

  • Fluid shift - oedema
  • Nausea, vomiting
  • Ascites
  • Dyspnoea

Management:

  • Fluids + electrolytes
  • Anti- coat
  • Abdo paracentesis if relevant
  • Pregnancy termination
21
Q

Most common type of ovarian tumours

A

Epithelial ovarian tumours - serous carcinomas

22
Q

Spread of ovarian cancer

A

Local invasion
Lymph
Para-aortic lymph

23
Q

Risk factors for ovarian cancer

A

Older age
Smoking
Increased number of ovulations - early menarche, late menopause
HRT
Obesity
BRCA

24
Q

Protective factors for ovarian cancer

A

Reduced number of ovulations - parity, breastfeeding, COCP, early menopause

25
Q

Presentation and investigations of ovarian cancer

A

Presentation:
- Abdo discomfort
- Bloating
- Early satiety

Investigations:

  • CA-125
  • Pelvis and abdo US
  • AFPand b-HCG
26
Q

Types of emergency contraceptions

A

IUD

  • Most effective
  • Stops implantation
  • Can be used 5 days after UPSI or earliest ovulation date

Ella-one, ulipristal:

  • Delays ovulation
  • Can be used up to 120hrs after UPSI
  • Not for severe asthma
  • Can’t breast feed after for 1 week
  • Reduces efficacy of hormonal contraception for 5 days

Levonelle, levonorgestrel:

  • Delays ovulation
  • Up to 72 hrs after UPSI
  • Double dose if BMI over 26
27
Q

How long it takes for contraception to become effective

A

IUD - instant
POP - 2 days
COC, injection, implant, IUS - 7 days

Any are immediate if start on first day of period

28
Q

Endometriosis

A

Growth of endometrial tissue outside the uterus
Worse during luteal phase due to increasing proliferation in response to increasing oestrogen

Presentation:

  • Deep dyspareunia
  • Subfertility
  • Urinary symptoms, dyschezia
  • Reduced organ motility OE

Investigation:

  • US - often normal
  • Laparoscopy

Mananagement:

  • NSAIDs +/paracetamol
  • COCP or progestogens
  • GnRH - to induce pseudomenopause
  • Surgery - laparoscopic excision or ablation of endometriosis / adhesions

Mod B (5 decks)

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